American College of Chest Physicians, Oct. 17-20

The annual meeting of the American College of Chest Physicians was held virtually this year from Oct. 17 to 20 and attracted participants from around the world, including specialists and heath care professionals focused on pulmonary, critical care, and sleep medicine. The conference featured presentations focusing on clinical updates in thoracic medicine.

In one study, Nicole Herbst, M.D., of the Emory University School of Medicine in Atlanta, and colleagues found that COVID-19-related visitation restrictions have had a significant impact on intensive care unit (ICU) providers' standard practices and job satisfaction.

The authors sent an anonymous online survey to ICU providers (i.e., residents, nurse practitioners, and physician assistants) working in any ICU setting (medical, surgical, or neurologic) to explore communication practices, attitudes on visitation restrictions, and symptoms of burnout. According to the researchers, 71.4 percent of providers reported that COVID-19-related visitation restrictions had a negative impact on job satisfaction, and 51.8 percent of providers reported symptoms of burnout.

"Prior research shows that communication practices in the ICU are important to families and patients, and COVID-19 has significantly changed these practices," Herbst said. "Understanding ways visitation restrictions impact providers, patients, and families can help guide future interventions to improve communication and provider job satisfaction."

Abstract

In a retrospective study, Malvika Kaul, M.D., of the University of Illinois in Chicago, and colleagues found that paradoxical bronchospasm is often not recognized or reported in spirometry test results among U.S. military veterans.

The authors reviewed pulmonary function test results and evaluated whether spirometry results met the criteria for paradoxical bronchospasm, defined as a decrease in forced expiratory volume in 1 second and/or forced vital capacity after use of a bronchodilator. The researchers found that paradoxical bronchospasm was not reported in test reports, even though presence of this phenomenon is displayed during spirometry assessment.

"In practice, recognizing/knowing about this entity and its clinical consequences in obstructive lung disease is important. We highlighted the lack of reporting of this entity and hence possibly missing its clinical implications in our study," Kaul said. "We think this phenomenon should be readily recognized by physicians in practice and its effect on patients' underlying lung disease management evaluated."

Abstract

In a retrospective chart study, Rohit Reddy, of the Thomas Jefferson University Hospital in Philadelphia, and colleagues found that COVID-19 patients with refractory acute respiratory distress syndrome (ARDS) who received extracorporeal membrane oxygenation (ECMO) after October 2020 experienced higher mortality than those who received ECMO prior to that date.

The authors reviewed the charts of all patients who were placed on ECMO for COVID-19 ARDS between April 2020 and March 2021. Patients were stratified to the first wave if ECMO was initiated prior to October 2020 and to the second wave if ECMO was initiated after October 2020. The researchers found that second-wave patients who underwent ECMO for COVID-19 ARDS experienced greater mortality on ECMO than first-wave patients who underwent ECMO for COVID-19 ARDS, despite revisions to pre-ECMO treatment algorithms.

"Control of infection is challenging for patients on immunomodulatory therapy who are placed on ECMO, but is crucial for improving outcomes," Reddy said. "More research may be required to revise ECMO inclusion and exclusion criteria to improve outcomes. It is also necessary to closely monitor patients on immunomodulatory therapy for infection as well as improve pre-ECMO management of COVID-19 to prevent patients from developing critical illness."

Abstract